About 2.5% of all people living with sickle cell disease aged ten years and above had active leg ulcers when data from CSSCD was retrieved and none of those who were below ten years.
These ulcers usually affect the medial or lateral surfaces of the ankles. They tend to have male preponderance and in older people. Having an α-gene deletion, high total haemoglobin and high levels of fetal haemoglobin lower the risk of suffering the ulcers. On the contrary, though severe anaemia, trauma and infection increase the risk.
They can be small and mild, or deep and severe. Their severity depends on the depth and duration. A common complication of deep leg ulcers is osteomyelitis of the nearby bones.
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Clinicians can assess osteomyelitis using an MRI, bone scan and bone biopsy.
Care for the ulcers is multidisciplinary as we happen to see in the following recommendations as put forth by the expert panel on evidence-based management of sickle cell disease.
- Inspect the lower extremities during the physical examination for active or healed ulcers, record their number and measure their depth.
- Treat leg ulcers in patients with sickle cell disease with initial standard therapy (debridement, wet to dry dressings and topical agents).
- Evaluate people with chronic recalcitrant deep leg ulcers for osteomyelitis.
- Evaluate possible aetiologies of leg ulcers to include venous insufficiency. Perform wound culture if an infection is suspected or if ulcers deteriorate.
- Treat with systemic or local antibiotics if a leg ulcer site is suspicious for infection and wound culture is definitive and organism susceptible.
- Consult or refer to a wound care specialist or multidisciplinary wound team for persistent or recalcitrant leg ulcers.
Care should be taken to prevent trauma to the legs of people with sickle cell disease, especially sickle cell anaemia, and treat any infections adequately and promptly.